Who pays? The cost of education

Consultation has begun to find a compromise on federal support for ongoing medical education

Amid talk of deficits, disability care and the Gonski plan, one Saturday afternoon before the 2013 federal Budget, Treasurer Wayne Swan announced a new $2000 cap on tax deductions for work-related self-education expenses.

It meant that as of 1 July 2014, anything anyone spends over $2000 on work-related education would no longer qualify for a tax concession.

“Without a cap on the amount that can be claimed under this deduction, it’s possible to make large claims for expenses such as first-class airfares, five-star accommodation and expensive courses”, read the 13 April press release, issued from Brisbane.

The current arrangements, it stated, provide an opportunity “for people to enjoy significant private benefits at taxpayers’ expense”.

The medical profession responded swiftly. More than 4000 Australian Medical Association (AMA) members vented their opinions in an AMA online poll, with 98% saying the cap would impair their professional development as a doctor. It was the largest ever response to a single issue.

Nonetheless the new cap was there in the 14 May Budget, with a government forecast of $514 million in savings thanks to the cap.

The savings have been allocated as a “down payment” towards national education reform.

“It’s going to slow down training, it’s going to slow down our ability to keep up to date”, AMA president Dr Steve Hambleton tells the MJA.

“If there are people misusing the current rules, that’s fine, we’re not going to stop the government tracking them down. But these are legitimate self-education expenses for people to upgrade their skills so they can use them to assist the people of Australia.”

Continuing professional development (CPD) is an obligation for the entire medical profession. The Medical Board, the RACGP and other specialist colleges require CPD for ongoing registration.

For some, these expenses can be high. International travel plays a role, with the bulk of research, development and networking in many specialties occurring in other parts of the world.

But there have been extreme examples of expensive programs of limited value — trips to exotic locations with a professional education component. Just what education will be provided is often very vague when the bookings are made.

Terry McMaster of McMasters’ Accountants, Solicitors and Financial Planners says that if he were a betting man he would put his money on the prospects that after further consultation between the AMA and Canberra, a compromise will see the cap lifted but increased regulation of the training providers, to reign in the less conventional options.

“I expect you will see some refinement to the rules, probably based on accrediting the training to filter out the silly CPD and leave the real CPD.”

Mr McMaster makes the point that if the cap is introduced, there are other ways of covering education costs, perhaps by tax benefits on increased college fees, and that the final restriction may only apply to employees.

“It’s not completely clear yet.”

At the other end of the spectrum, much is provided at minimal cost or for free, and that is likely to increase as the capacity for effective online education improves.

Such courses could even eliminate the travel cost burden borne by rural and remote practitioners and reduce international travel requirements.

Thanks to these developments it is already often possible for a general practitioner to fulfil their triennial CPD requirements for a fraction of the proposed $2000 per year cap.

But few, if any, believe that online courses should replace face-to-face events.

NSW GP Dr David Rivett, a long-time advocate for rural doctors and chair of the AMA Rural Medicine Committee, was attending the Australian and New Zealand College of Anaesthetists’ 2013 annual conference in Melbourne when the MJA spoke with him.

He said that the conventions at “the distal end of sensibility” should be disallowed, but online education can’t replace the professional development of the conventional convention experience.

“There’s not the same stimulation as mixing with people and talking with people after meetings about their experiences. And some of the networking opportunities are huge.”

The conference he was currently attending had provided an opportunity for hands-on experience with new equipment his local hospital had just purchased, and to meet doctors who were interested in doing locums in his region.

“The networking part of it is also very valuable and feeds back into better care in regional areas.”

Junior doctors

If the cap is imposed, the change will be felt most acutely by registrars and junior doctors — those earning least but with the greatest self-education costs.

“A junior doctor who’s doing a specialty, trying to get background courses, pay their college fees, and attend three or four extra training courses for the year, is going to spend a lot of money”, Dr Hambleton says.

Dr Gerry Considine is one such junior doctor. This year he will sit his Royal Australian College of General Practitioners fellowship exams at a cost of more than $6655. That doesn’t account for travel and accommodation costs for the rural South Australia trainee.

Within the past three years, he has spent:

• $2000–3000 on emergency skills
• $1000–2000 to upskill in ultrasound
• $200–300 for an x-ray licence (annual)
• $2000 for the Advanced Paediatric Life Support (every five years)

In addition, the politically engaged registrar has attended three to four conferences each year at additional cost. To date, the most exotic location has been Canberra, but it all adds up, he says.

An avid blogger (www.ruralflyingdoc.com), Dr Considine says he is passionate about online education, but doesn’t believe it could ever replace face-to-face meetings.

“What’s getting lost in the message is the necessary upskilling that happens especially for those rural doctors like me. If you don’t have those skills, then your patients’ care is also compromised.”

The AMA is now in post-Budget negotiations with the government, alongside other affected professional groups, in an effort to craft a compromise.